Respiratory Failure due to Possible Donor-Derived Sporothrix schenckii Infection in a Lung Transplant Recipient

Area of Science:

• Transplant Infectious Diseases
• Mycology
• Immunocompromised Hosts

Background:

• Invasive fungal infections (IFIs) are significant causes of morbidity and mortality in solid organ transplant (SOT) recipients.
• Donor-derived IFIs (DDIFIs) pose a risk, with mandatory reporting to the Organ Procurement Transplant Network since 2005.
• Systematic monitoring for DDIFIs in the US predates 2005 was limited.

Purpose of the Study:

• To report the first case of sporotrichosis in a lung transplant recipient.
• To highlight the potential for donor-derived fungal infections in SOT.
• To review the implications of Sporothrix in transplant recipients.

Main Methods:

• A case presentation of a 49-year-old male lung transplant recipient with primary graft dysfunction and bilateral infiltrates.
• Isolation of Sporothrix schenckii from bronchoalveolar lavage on post-transplant day 2.
• Treatment initiated with amphotericin B lipid formulation.

Main Results:

• The patient presented with diffuse patchy bilateral infiltrates, suggestive of pulmonary Sporothrix infection.
• Clinical and radiographic improvement was observed following amphotericin B therapy.
• The early isolation timing suggested a donor-derived infection.

Conclusions:

• This case represents the first reported instance of sporotrichosis in a lung transplant recipient.
• The patient achieved a positive outcome with induction therapy (amphotericin B) and maintenance therapy (itraconazole).
• Early recognition and prompt management of fungal infections, including Sporothrix, are vital for improving outcomes in transplant patients.